Treatment - Coeliac disease

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Coeliac disease is usually treated by simply excluding foods that contain gluten from your diet.

This prevents damage to the lining of your intestines (gut) and the associated symptoms, such as diarrhoea and stomach pain.

If you have coeliac disease, you must give up all sources of gluten for life. Your symptoms will return if you eat foods containing gluten, and it will cause long-term damage to your health.

This may sound daunting, but your GP can give you help and advice about ways to manage your diet. Your symptoms should improve considerably within weeks of starting a gluten-free diet. However, it may take up to two years for your digestive system to heal completely.

Your GP will offer you an annual review during which your height and weight will be measured and your symptoms reviewed. They'll also ask you about your diet and assess whether you need any further help or specialist nutritional advice.

A gluten-free diet

When you're first diagnosed with coeliac disease, you'll be referred to a dietitian to help you adjust to your new diet without gluten. They can also ensure your diet is balanced and contains all the nutrients you need.

If you have coeliac disease, you'll no longer be able to eat foods that contain barley, rye or wheat, including farina, graham flour, semolina, durum, cous cous and spelt.

Even if you only consume a small amount of gluten, such as a spoonful of pasta, you may have very unpleasant intestinal symptoms. If you keep consuming gluten regularly, you'll also be at greater risk of developing osteoporosis and cancer in later life.

As a protein, gluten isn't essential to your diet and can be replaced by other foods. Many gluten-free alternatives are widely available in supermarkets and health food shops, including pasta, pizza bases and bread. Some GPs may provide gluten-free foods on prescription.

Many basic foods – such as meat, vegetables, cheese, potatoes and rice – are naturally free from gluten so you can still include them in your diet. Your dietitian can help you identify which foods are safe to eat and which aren't. If you're unsure, use the lists below as a general guide.

Foods containing gluten (unsafe to eat)

If you have coeliac disease, don't eat the following foods, unless they're labelled as gluten-free versions:

bread

pasta

cereals

biscuits or crackers

cakes and pastries

pies

gravies and sauces

It's important to always check the labels of the foods you buy. Many foods – particularly those that are processed – contain gluten in additives, such as malt flavouring and modified food starch.

Gluten may also be found in some non-food products, including lipstick, postage stamps and some types of medication.

Cross-contamination can occur if gluten-free foods and foods that contain gluten are prepared together or served with the same utensils.

Gluten-free foods (safe to eat)

If you have coeliac disease, you can eat the following foods, which naturally don't contain gluten:

most dairy products, such as cheese, butter and milk

fruit and vegetables

meat and fish (although not breaded or battered)

potatoes

rice and rice noodles

gluten-free flours, including rice, corn, soy and potato

By law, food labelled as gluten free can contain no more than 20 parts per million (ppm) of gluten.

For most people with coeliac disease, these trace amounts of gluten won't cause a problem. However, a small number of people are unable to tolerate even trace amounts of gluten and need to have a diet completely free from cereals.

Oats

Oats don't contain gluten, but many people with coeliac disease avoid eating them because they can become contaminated with other cereals that contain gluten.

There's also some evidence to suggest that a very small number of people may still be sensitive to products that are gluten-free and don't contain contaminated oats. This is because oats contain a protein called avenin, which is suitable for the majority of people with coeliac disease, but may trigger symptoms in a few cases.

If, after discussing this with your healthcare professional, you want to include oats in your diet, check the oats are pure and that there's no possibility contamination could have occurred.

You should avoid eating oats until your gluten-free diet has taken full effect and your symptoms have been resolved. Once you're symptom free, gradually reintroduce oats into your diet. If you develop symptoms again, stop eating oats.

pneumococcal vaccine, which protects against infections caused by the Streptococcus pneumoniae bacterium

However, if your spleen is unaffected by coeliac disease, these vaccinations aren't usually necessary.

Supplements

As well as cutting gluten out of your diet, your GP or dietitian may also recommend you take vitamin and mineral supplements, at least for the first six months after your diagnosis.

This will ensure you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia (a lack of iron in the blood).

Dermatitis herpetiformis

If you have dermatitis herpetiformis (an itchy rash that can be caused by gluten intolerance), cutting gluten out of your diet should clear it up.

However, it can sometimes take longer for a gluten-free diet to clear the rash than it does to control your other symptoms, such as diarrhoea and stomach pain.

If this is the case, you may be prescribed medication to speed up the healing time of the rash. It's likely that this will be a medicine called Dapsone, which is usually taken orally (in tablet form) twice a day.

Dapsone can cause side effects, such as headaches and depression, so you'll always be prescribed the lowest effective dose.

You may need to take medication for up to two years to control dermatitis herpetiformis. After this time, you should have been following a gluten-free diet long enough for the rash to be controlled without the need for medication.

Refractory coeliac disease

Refractory coeliac disease is a rarer type of coeliac disease where the symptoms continue, even after switching to a gluten-free diet. The reasons for this are unclear.

It's estimated that around one in every 140 people with coeliac disease will develop the refractory form of the condition.

If refractory coeliac disease is suspected, it's likely you'll be referred for a series of tests to make sure your symptoms aren't being caused by another condition.

If no other cause can be found and the diagnosis is confirmed, you'll be referred to a specialist. Treatment options include steroid medication (corticosteroids), such as prednisolone, which help block the harmful effects of the immune system.